To understand ourselves, we can consider nocturnal intake syndrome within sleep disorders or eating disorders, depending on the state of consciousness that the person has during the episode of compulsive eating. In any case, it is a problem by which, during the night and after dinner, the person gets up and ingests large amounts of food without control, with preference for high-calorie and high-carbohydrate foods.
It is estimated that it is a disorder that affects 1.5% (Germany, 2014) and that it has serious consequences for health (Zwaan, Muller, Allison, Brahler, & Hilbert, 2014). That is why in this publication we will talk about what is the syndrome of nocturnal intake and how it manifests, why this problem occurs, what are its causes and how is its treatment. Because although it is a rare and somewhat unknown problem, it deserves our full attention.
Nocturnal intake syndrome: what it is and what symptoms it has
The nocturnal intake syndrome was identified by Dr. Albert Stunkard in 1955 and is currently considered a sleep disorder and not an eating disorder. The manual for the classification of mental illnesses (DSM-5) classifies it as a disorder of awakening in non-REM sleep or as an eating disorder not specified according to the state of consciousness of the individual during the episode of intake. We will turn to see these two cases below.
"The nocturnal intake syndrome may belong to sleep disorders or eating disorders depending on the state of consciousness that the person has during the episode of compulsive eating."
When the intake occurs during sleep, and the person is not aware of it, we talk about the nocturnal intake syndrome as a sub-type of sleepwalking: it occurs in phase IV of the sleep characterized by having slow waves and a very deep sleep. What happens is that the person gets up and eats compulsively and without realizing it, since he is not conscious although he seems awake and can open the fridge, chew and swallow. Thus, as occurs in sleepwalking, there is no awareness of the acts and nothing is remembered of what was done the next morning.
On the other hand, when we talk about nocturnal intake in a period of time in which the person is aware at all times that he is eating, generating this episode a memory, we talk about other eating disorders not specified according to the DSM-5 and It is called "Nighttime food ingestion syndrome".
In this case the compulsive intake is also given, but there is a certain voluntariness in this behavior and it is remembered what has been done. While when nighttime intake occurs with sleep disturbances, none of this is observed, simply a pattern of compulsive and nocturnal eating without being conscious and "awakened" by the phase of sleep in which this phenomenon occurs.
What are the symptoms of nocturnal intake syndrome?
If the nocturnal intake occurs as an eating disorder, it is easy to diagnose because frequent episodes of compulsive eating are observed when getting up or before going to sleep. That is, it can be observed in the person as if it were an addiction to food: even if one does not want to eat and even the person maintains the purpose of losing weight, the binge episode is performed. Although it is difficult to admit and recognize, it is an observable behavior because the person is conscious while eating at night in an uncontrolled way.
However, if the nocturnal intake is given as a sleep disorder, the symptoms can be very difficult to identify. The most frequent way to detect nocturnal intake syndrome as a sleep disorder is that the person is found eating "asleep" or because he begins to gain weight without knowing why; In addition, it is observed that overnight food disappears from the refrigerator and no one remembers having eaten it. But being a problem that occurs in the deep phase of sleep and waking up in this phase is very difficult, it is more complicated that the same subject who has the disorder is able to realize what is happening.
To summarize, the nocturnal intake syndrome can be an eating disorder or it can be a sleep disorder (it is a subtype of sleepwalking). In all cases it is an exaggerated and compulsive eating pattern that occurs during the night, after dinner when the person has already eaten and has satiated, discarding other psychological or psychiatric problems.
Why does this problem occur and what are the causes?
In the case of compulsive eating as an eating disorder, the problem occurs because food is an escape route in the face of anxiety and depression. Eating becomes a coping strategy for discomfort and problems; It develops as if it were an addiction to food and that is why, in the nocturnal intake, the person feels an urge to eat food and nothing calms him until he eats.
On the other hand, when food intake occurs during sleep, we are facing a syndrome that occurs because there is a "failure" in the awakening, the person wakes up when he is not ready to do so and then activates his motor system (the voluntary movement) and "automatisms" or very learned behaviors such as walking, talking and eating are set in motion. That's why most people with nighttime intake are not aware of their behavior and may wake up while they are eating without understanding what they are doing and how they got there.
In all cases, the nocturnal intake syndrome is more common in people who are already obese and is usually associated with hormonal imbalances (melatonin and stress hormones) and neurotransmitters, such as serotonin. Therefore, different scientific studies explain how nighttime intake can be successfully treated with drugs such as selective serotonin reuptake inhibitors (SSRIs), melatonin (sleeping hormone) and medication that seeks to reduce the response to Stress (Zapp, Fischer, & Deuschle, 2017).
At a general level, imbalances in sleep and circadian rhythm usually lead to nocturnal intake. Although the causes of this disorder are multiple and little known, today it is assumed that factors such as anxiety, stress, obesity and circadian maladies are the most frequent causes. Coping strategies focused on emotion and not on the problem are also related to compulsive eating syndrome, and on these the psychological intervention must focus.
"Eating becomes a strategy to cope with discomfort and problems and develops as if it were an addiction to food and that is why nighttime intake, the person feels an urge to eat and nothing calms him until he eats" .
